Tuberculosis deaths are increasing for the first time in 15 years — and it’s because of COVID.
Things seem to be getting worse since the World Health Organization (WHO) rang the alarm in a report in November. At the time, it cited approximately 1.5 million tuberculosis deaths worldwide in 2020 — the first time tuberculosis deaths had risen since 2005.
While it’s easy to think of tuberculosis as an illness of the past, it’s still the leading cause of death from infectious disease. Cases began to rise during the AIDS crisis in the 1980s, when many AIDS patients were unable to fight off the infection because of their compromised immune systems. While North American cases began to decrease again the mid-90s, according to the Mayo Clinic, it remains common in many parts of Africa, Asia and Latin America. Sixty per cent of worldwide tuberculosis cases are in just six countries: India, Indonesia, China, Nigeria, Pakistan and South Africa.
TB is the leading cause of death from infectious disease
TB primarily infects the lungs. Like COVID, it’s transmitted from tiny droplets in the air. There is no effective adult vaccine for TB, and part of what can make it deadly is that many strains are antibiotic-resistant.
The November report found that treatment for people with COVID resulted in treating fewer TB patients. And while fewer people were diagnosed with or treated for TB, more people died from it, which, according to the WHO, seems to indicate a lack of access to medical care.
“This report confirms our fears that the disruption of essential health services due to the pandemic could start to unravel years of progress against tuberculosis,” WHO director-general Dr. Tedros Adhanom Ghebreyesus said at the time. “This is alarming news that must serve as a global wake-up call to the urgent need for investments and innovation to close the gaps in diagnosis, treatment and care for the millions of people affected by this ancient but preventable and treatable disease.”
Vaccine inequity is a big part of the problem, according to a piece published in the New England Journal of Medicine earlier this month, written by three of the world’s leading experts on tuberculosis, including McGill epidemiology professor Dr. Madhukar Pai.
Poverty and malnutrition are significant parts of the spread of tuberculosis, the authors wrote: “In 2020, the COVID-19 pandemic pushed 100 million people into poverty. Nearly 20 per cent of global tuberculosis incidence is attributable to undernutrition.”
And countries with high levels of poverty and malnutrition are also countries with limited access to the COVID vaccine. More COVID cases in those areas will also mean more TB deaths. Countries in southern Africa, the authors point out, “are experiencing massive COVID-19 surges on top of already high tuberculosis and HIV co-infection burdens.”
Tuberculosis is not only affecting far-away countries
But the issue is close to home, too: Nunavut declared a TB outbreak in November, prompting territory health authorities to figure out how to contain it — and then Omicron hit.
“Once COVID came, we totally lost track of the TB stuff,” Eric Lawlor, the mayor of Pangnirtung, Nunavut told The Canadian Press last week.
TB disproportionally affects the Inuit, who make up the majority of the Nunavut population. In fact, the average rate of TB is 290 times higher among the Inuit than non-Indigenous Canadian people, according to the Public Health Agency of Canada.
Helping to drive the spread of both TB and COVID is the territory’s housing crisis, as both diseases are spread easily through person-to-person contact. “Housing is the biggest issue we face,” Lawlor said. “There are multiple families per house. People are sleeping on couches.”
But he also added that residents are following public health guidelines — 80 per cent of Nunavut residents have received at least one dose of the COVID vaccine.
The most effective way to deal with the TB crisis would be to end the pandemic, the TB researchers said: “Without global vaccination, health care systems in low- and middle-income countries will collapse.”
Editor’s note: A previous version of this story incorrectly stated that there is no vaccine for TB. There is one, the Bacille Calmette-Guérin vaccine, although it is used rarely, only given to young children, and “not recommended for routine use in any Canadian population,” according to Health Canada.